Real-world evidence of direct oral anticoagulants in patients with atrial fibrillation and cancer: A meta-analysis

Background: Several observational cohort studies have been conducted to investigate the effectiveness and safety of direct oral anticoagulants (DOACs) compared with vitamin K antagonists (VKAs) in patients who have both atrial fibrillation (AF) and cancer. Herein, we conducted a meta-analysis to present a comprehensive overview of the real-world evidence on DOACs in patients with AF and cancer.<br /> Methods: A comprehensive search strategy was performed in PubMed and Embase until February 2024 for studies that enrolled AF patients with cancer who received DOACs or VKAs. The adjusted risk ratios (RRs) and 95% confidence intervals (CIs) of each outcome were extracted and pooled by a random-effects model. Results: Seven observational cohort studies were eligible for data extraction. The random-effects model analysis indicated that compared with VKA use, the use of DOACs was significantly associated with reduced risks of stroke or systemic embolism (RR=0.79, =0.79, 95 % CI 0.64---0.97), major bleeding (RR=0.84, =0.84, 95 % CI 0.71---0.99), intracranial bleeding (RR=0.61, =0.61, 95 % CI 0.54---0.69), and gastrointestinal bleeding (RR=0.87, =0.87, 95 % CI 0.80---0.95) in AF patients with concurrent cancer. Conclusions: Compared with VKAs, the use of DOACs was associated with decreased risks of thrombotic and bleeding events in AF patients with cancer. Data from real-world scenarios support the use of DOACs as a favorable treatment option for this specific patient population.